Cumulative dose: A simple infographic for referrers and patients

Communicating radiation risks effectively is critical in imaging examinations, especially for ensuring the benefit-risk justification among radiologists, medical physicists, referrers, radiation technologists, and patients. Imaging modalities such as CT, fluoroscopic guided interventions, and PET/CT pose challenges due to high cumulative radiation exposure in patients who require recurrent imaging. In recent years there has been a strong emphasis on assessing the cumulative effective doses (CED) in patients who undergo recurrent imaging for disease surveillance. In addition, while referral guidelines of the Royal College of Radiologists (RCR) and the American College of Radiology (ACR) have used symbolic representations like trefoil radiation symbols to simplify dose communication, there is a lack of similar efforts to communicate cumulative doses. While absolute dose metrics like millisieverts (mSv) or milligray (mGy) are scientifically essential, they often fail to provide intuitive understanding for non-specialists. We wish to extend the concept of radiation symbol use for communicating CED. The stacking of the trefoil symbol to represent cumulative dose has been proposed in this article by taking one symbol to represent 50 mSv. This approach can be built into referral guidelines to facilitate informed decision-making for chronic conditions requiring lifelong imaging and supports risk communication with patients. Incorporating cumulative dose symbols into referral guidelines and clinical workflows will provide a practical step toward optimizing radiation use while safeguarding patients against potential long-term effects. Such advancements align with the growing emphasis on patient-centric care and evidence based imaging practices.